<!DOCTYPE html>
<html>
    <head>
        <title>育宝|绑定银行信息</title>
        <meta charset="UTF-8">
        <meta name="viewport" content="initial-scale=1, maximum-scale=1, user-scalable=no">
        <meta name="format-detection" content="telephone=no">
        <link rel="stylesheet" href="__PUBLIC__/libs/frozenui/css/frozen.css">
        <link rel="stylesheet" href="__PUBLIC__/Mobi/style.css">
        <script src="__PUBLIC__/Anal/js/jquery.js"></script>
    </head>
    <body>
        <p class='title'>绑定银行卡</p>
        <div class="ui-form ui-border-t" id="index">
            <form action="{:U('Apn/updateinfo')}" method="post">

                <div class="ui-form-item ui-border-b">
                    <label>姓名:</label>
                    <input type="text" name="ssa_name" placeholder="请输入您的姓名." required/>
                </div>

                <div class="ui-form-item ui-border-b">
                    <label>性别:</label>
                    <div class="ui-select">
                        <select name="ssa_sex">
                            <option selected value="1">男</option>
                            <option value="0">女</option>

                        </select>
                    </div>

                </div>
                <div class="ui-form-item ui-border-b">
                    <label>销售码:</label>
                    <input type="text" name="code" placeholder="请输入您的销售码." required/>
                </div>
                <div class="ui-form-item ui-border-b">
                    <label>注册手机号:</label>
                    <input type="text" name="phone" placeholder="请输入您的手机号码." required/>
                </div>
                <div class="ui-form-item ui-border-b">
                    <label>银行卡号</label>
                    <input type="text" name="bankcard" placeholder="请输入您的银行卡号." required/>
                </div>
                <div class="ui-form-item ui-border-b">
                    <label>开户姓名</label>
                    <input type="text" name="bankname" placeholder="请输入您银行卡开户姓名." required/>
                </div>
                <div class="ui-form-item ui-border-b">
                    <label>开户银行</label>
                    <div class="ui-select">
                        <select name="banktype">
                            <option>中国工商银行</option>
                            <option>中国农业银行</option>
                            <option>中国银行</option>
                            <option>中国建设银行</option>
                            <option>中国交通银行</option>
                        </select>
                    </div>
                </div>

                <div class="ui-form-item ui-border-b">
                    <label>微信账号</label>
                    <input type="text" name="ssa_wechat_account" placeholder="请输入您微信收款账号." required/>
                </div>

                <div class="ui-form-item ui-border-b">
                    <label>支付宝账号</label>
                    <input type="text" name="ssa_alipay_account" placeholder="请输入您支付宝收款账号." required/>
                </div>

                <div class="ui-form-item ui-border-b">
                    <label>居住地址</label>
                    <input type="text" name="ssa_addr" placeholder="请输入您居住地址." required/>
                </div>

                <div class="ui-form-item ui-border-b">
                    <label>填表日期</label>
                    <input type="text" name="ssa_created_at" placeholder="请输入您填表日期." required/>
                </div>

                <div class="ui-form-item ui-border-b">
                    <label>代理到期日期</label>
                    <input type="text" name="ssa_expired_at" placeholder="请输入您代理到期日期." required/>
                </div>

                <div class="ui-btn-wrap" style="text-align:center;">
                    <button class="ui-btn ui-btn-danger" id='btn1'>提交</button>
                </div>
            </form>
        </div>

    </body>
</html>
